Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study.

BACKGROUND: Although the term acute renal failure was replaced by acute kidney injury (AKI) recently, there is a paucity of data on the incidence and profile of AKI in critically ill children from the developing world. OBJECTIVES: The objective of this study is to determine the incidence, etiology, short term outcome and predictors of fatality in critically ill children admitted to the pediatric intensive care unit (PICU) with AKI, aged 1 month to 13 years. MATERIALS AND METHODS: In this prospective observational study, from June 2010 to March 2011, 215 children admitted to the PICU were screened for AKI, defined according to the AKI Network criteria. The patients with AKI were followed-up until discharge/death. Their clinical and biochemical data were recorded. RESULTS: The incidence of AKI among 215 patients screened was 54 (25.1%). The common etiologies were infections, [34 (62.9%)], acute glomerulonephritis (7.6%), snake envenomation (5.7%), hemolytic uremic syndrome (3.8%) and congestive cardiac failures (3.8%). Among infections, pneumonia and septicemia constituted 26.5% each, meningoencephalitis accounted for 23.5%, and dengue, scrub typhus, tuberculosis and malaria constituted 9.3% of children with AKI. 27.8% of patients required dialysis. Overall mortality was 46.3%. On logistic regression analysis, requirement of mechanical ventilation was an independent predictor of fatality in AKI. CONCLUSIONS: Besides the high incidence of AKI in critically ill-children admitted to the PICU (25.1%), the condition was associated with adverse outcomes, including high mortality (46.3%) and need for dialysis (27.8%). Infections dominated the etiological profile. Requirement of mechanical ventilation predicted an adverse outcome in our patient population.

Breast feeding practices among health care professionals in a tertiary care hospital from South India.

Personal breastfeeding experiences of health care professionals play a major role in influencing their attitudes and expertise regarding counseling and managing breastfeeding issues in patients. This study was done with an objective of studying the current breastfeeding practices among health care professionals (HP) and their spouses and the factors influencing them. All children < 5 years of age, residing in hospital's residential quarters, were included. A detailed breastfeeding history demographic data were obtained following a semi-structured interview with mothers. Among 81 children included for analysis, in 73 children (90.1%), an initiation of breastfeeding was within 24 hours of birth and in 36 children (44.4%), it was within first hour of life. 43 children (58.1%) were exclusively breast fed for 6 months. Mean duration of EBF was 5.3 months and total duration of breastfeeding was 13.2 months. Gender of HP, gender of the child and socio-economic factors were not found to significantly affect breastfeeding practices among HP.

Fanconi-Bickel syndrome in a 3-year-old Indian boy with a novel mutation in the GLUT2 gene.

Fanconi-Bickel syndrome is a rare autosomal recessive disorder characterized by hepatorenal glycogen accumulation, proximal renal tubular dysfunction and impaired utilization of glucose and galactose. Most cases have been reported from Europe, Japan, Turkey and the Mediterranean belt. We report a 3-year-old boy from southern India who presented with doll-like facies, florid rickets, massive hepatomegaly, growth retardation, renomegaly and laboratory evidence of proximal renal tubular dysfunction. Liver biopsy demonstrated evidence of glycogenosis. Direct sequencing of genomic DNA confirmed a diagnosis of Fanconi-Bickel syndrome, revealing a G-to-A substitution at position -1 of the splicing acceptor site in intron 1 of the GLUT2 gene in a homozygous pattern (c.16-1G>A or IVS1-1G>A). This novel mutation has not been described in earlier studies. The child was treated with oral potassium citrate, oral phosphorus supplementation, and alpha-calcitriol, on which metabolic derangements were corrected.

Incidence and etiology of acute kidney injury in southern India.

OBJECTIVES: To determine the incidence, etiology, short term outcome and predictors of mortality in hospitalized children aged 1 mo to 13 y with Acute Kidney Injury (AKI). METHODS: This prospective observational study was conducted in the pediatric wards and the pediatric intensive care unit (PICU) of a tertiary hospital in southern India, to study the clinico-etiological profile of AKI (defined according to the Acute Kidney Injury Network criteria). From June 2010 through March 2011, 2376 children were included in the study. RESULTS: The incidence of AKI was 5.2 % in the pediatric wards and 25.1 % in the PICU. AKI occurred in association with infections (55.4 %), acute glomerulonephritis (16.9 %), cardiac disease (4.8 %), envenomations (4.2 %) and hemolytic uremic syndrome (3.6 %). Pneumonia constituted 26.1 % of the infections. Tropical febrile illnesses (dengue, scrub typhus, enteric fever, cholera, tuberculosis, malaria and leptospirosis) constituted 15.6 % of children with AKI. Dialysis was required in 14.5 % of patients; mortality was 17.5 %. A significant proportion of children (17.5 % of survivors) had partial renal recovery at discharge. On multivariate logistic regression, dysnatremia and meningoencephalitis were independent predictors of mortality in AKI. CONCLUSIONS: The incidence of AKI is high in the patient population, including the non-critically ill children. AKI continues to be associated with adverse outcomes. Presence of dysnatremia and meningoencephalitis are poor predictors of outcome in AKI.

Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications.

OBJECTIVE: To study the clinical profile of and complications in children with scrub typhus. DESIGN: Prospective observational study. SETTING: Tertiary care hospital. METHODS: Children up to 12 years of age who had a fever for more than five days without an identifiable infection were included. All children who were suspected of having rickettsial infections were defined as having scrub typhus if they had a positive Weil-Felix test result (OX-K 1:80 or more) and one or more of the following clinical features (after exclusion of other diagnoses): rash, edema, hepatosplenomegaly, lymphadenopathy, an eschar, and a tick bite or tick exposure. RESULTS: Thirty-five children were diagnosed with scrub typhus between February 2010 and February 2011. The age of the patients ranged from 1.5 to 12 years. Edema, crackles/rhonchi, hepatomegaly and hypotension were encountered in 60%, 23%, 91% and 34% of patients, respectively. An eschar was observed in 11% of the cases. Complications included myocarditis with cardiogenic shock in 34% of the cases and acute kidney injury in 20% of the cases. Anicteric hepatitis and thrombocytopenia were observed in 31% and 61% of cases, respectively. One patient died. CONCLUSIONS: High incidences of myocarditis and acute kidney injury were observed, which indicates that the children were treated at a late stage of the disease. Clinicians should be cognizant that myocarditis and acute kidney injury are serious manifestations of pediatric scrub typhus.

Kartagener syndrome associated with mesangioproliferative glomerulonephritis.

An 11-year-old girl with clinical features of Kartagener syndrome presented with signs of acute glomerulonephritis. Blood urea and creatinine were mildly elevated and anti-streptolysin O and C3 levels were normal. Renal biopsy demonstrated mesangial proliferation and direct immunofluorescence showed IgM and C3 deposits. This appears to be the first report of Kartagener syndrome in association with mesangioproliferative glomerulonephritis. The literature is reviewed and the possible mechanisms for this association are discussed.

Bilateral ptosis in a child following massive attack by a swarm of wasps.

Neurological manifestations of wasp sting are rare and the etiopathogenesis is not completely understood. We report a 2-year-old girl who developed bilateral ptosis after multiple wasp stings, which responded partially to pyridostigmine. This is the first reported case of wasp venom-induced ptosis in a child. We discuss the possible pathogenetic mechanisms behind this phenomenon.